CMS/EIP Fiscal Report Center: 03
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1571 1556.250000 57864.2000 37.1818
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 10.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2463 12214.25000 453796.8000 37.1531
Subtotal (Total Children Is Unduplicated) 2621 13781.25000 511661.0000 37.1273
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 6.000000 291.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 21 17.000000 850.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 36.500000 2637.5000 72.2603
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 24 44.500000 3337.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.000000 675.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 18.500000 1387.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 46.500000 2580.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 197 369.500000 27369.9000 74.0728
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 163 314.000000 22841.1500 72.7425
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 125 227.500000 17033.2500 74.8714
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 9.500000 670.5000 70.5789
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 479 951.500000 52808.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 22 42.000000 2331.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 86 150.000000 11250.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 6.000000 308.4600 51.4100
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 15 18.000000 897.9700 49.8872
PSTH-97162-PT EVAL MODERATE COMPLEXITY 8 8.000000 373.8700 46.7338
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 69 72.000000 3600.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 21 22.000000 1073.8800 48.8127
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 31 32.000000 1644.0400 51.3763
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.7200 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 10.000000 529.3000 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.5700 52.5700
Subtotal (Total Children Is Unduplicated) 933 2455.000000 157469.3700 64.1423
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 5.000000 631.9800 126.3960
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 458 619.000000 30925.0000 49.9596
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 341 375.000000 18750.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 6.750000 168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 48 83.750000 4187.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 31 38.000000 1900.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 127 240.750000 12037.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 34 39.500000 1975.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 93 235.250000 11762.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 8 10.750000 537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 177 502.250000 25112.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 56 115.250000 5762.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 111 259.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 77 111.750000 5587.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 336 2267.250000 113337.5000 49.9890
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 405 2792.000000 139600.0000 50.0000
INTR-T1013-INTERPRETER 17 129.000000 6282.5000 48.7016
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1045 12188.00000 121718.0000 9.9867
OCCT-97530-OT SESSION BY LICENSED OT 23 207.250000 14373.6800 69.3543
OCCT-97530GT-OT SESSION BY LICENSED OT 14 17.000000 1158.8300 68.1665
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 3.000000 214.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 61 631.250000 44416.8700 70.3634
PHY-97110GT-PT SESSION BY LICENSED PT 9 23.000000 1653.0000 71.8696
PHY-97110TL-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.750000 53.5800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 135 958.000000 63578.0100 66.3654
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 32 45.000000 3236.1200 71.9138
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 1.500000 55.5000 37.0000
TRAV-TRAVS-Travel by mile 997 224888.0000 100040.2700 0.4448
Subtotal (Total Children Is Unduplicated) 1344 246797.0000 729342.1700 2.9552
CMS/EIP Fiscal Report Center: 03
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
-----------------------------------------------------------------------------------------------------------------------
Total 263033.250000 1398472.5400 5.3167
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Number of Children (Unduplicated) With at Least One Service 2669
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Center 03
Flag Claims Units Chgs Paid
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R 103 139.500000 5189.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 5852 3847.500000 148370.7400 0.0000
P 28571 197462.750000 679570.1600 679494.0900
D 77 76.000000 3323.8500 0.0000
S 0 0.000000 0.0000 0.0000
H 1122 6711.750000 32224.3600 32211.8600
T 0 0.000000 0.0000 0.0000
20752 54567.000000 521001.7800 0.0000
Other 241 228.750000 8792.2500 0.0000
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Total 56718 263033.250000 1398472.5400 711705.9500